Fentanyl Is the Genie That Won’t Go Back in the Bottle
Two bandmates saw their sons both overdose on fentanyl in the space of a few years. The synthetic opioid crisis is more out of control than many realize, and the coronavirus pandemic has only made it worse.
When Axel was twelve, his dad Kirk took him to see Smash Mouth — his first concert. Soon Kirk, a musician, hauled a drum kit into their house outside of Providence, Rhode Island, and the two spent Axel’s early teenage years learning songs by his favorite bands like Fountains of Wayne.
This past New Year’s Eve, Kirk and Axel both coincidentally posted the same Counting Crows song on their Facebook pages. They each chose lyrics to accompany their posts, Kirk’s decidedly more optimistic than Axel’s.
Kirk went with: “A long December and there’s reason to believe/ Maybe this year will be better than the last.” Axel chose: “The smell of hospitals in winter/ And the feeling that it’s all a lot of oysters, but no pearls.”
Kirk isn’t quite sure which day in early January Axel overdosed. After a four-day radio silence, both of Axel’s parents rushed to the house where he was staying and found him lying in bed, cold to the touch. Afraid of what he might find inside, Kirk asked a family friend to read the medical examiner’s report. It concluded that Axel died from a massive fentanyl overdose.
Kirk’s son wasn’t the first young person he knew who had overdosed on fentanyl. A few years earlier, it happened to Kirk’s bandmate’s son too. The bandmates’ sons didn’t know each other and didn’t run in the same social circles — the fentanyl crisis is just that widespread and devastating overdoses just that ubiquitous around Providence and across the nation.
Opioid abuse and overdoses constituted a parallel epidemic, one furiously aggravated by the other public health crisis underway.
With a few exceptions, American news outlets have been quieter on the opioid crisis lately than in years past. But though the coronavirus pandemic elbowed the opioid crisis out of headlines, the latter hardly subsided. On the contrary, opioid abuse and overdoses constituted a parallel epidemic, one furiously aggravated by the other public health crisis underway.
Last month gave us a glimpse at just how badly the situation deteriorated over the course of the pandemic. A new Centers for Disease Control and Prevention (CDC) report found that more than 87,000 people died from drug overdoses — chief among them synthetic opioids like fentanyl — in the period between September 2019 to September 2020, a rate 28.8 percent higher than the preceding year. And that doesn’t include the period after September, when Axel died.
Kirk believes his son’s death is related to the coronavirus pandemic, which cut him off from meaningful activities at a vulnerable time in his life. Axel had spent years battling opioid addiction while trying to land a good, steady job. He mostly worked in pizzerias and always jumped at the chance to work the Christmas rush at UPS. His skills as a drummer had improved, and he played for a while in a rock band in Providence.
Finally, in 2019, Axel got a full-time unionized job on a loading dock at UPS. “That was the best job he ever had,” says Kirk. “He worked really hard, and he was proud of his work there. They appreciated him, and that really helped with his self-esteem.”
While working at UPS, Axel saw a doctor and got a prescription for Suboxone, a drug used to treat dependence on opioids. Kirk says he was on the mend. Then in mid-November, a coworker tested positive for COVID-19, and Axel was sent home to quarantine. “He texted me upset, because I think he knew how dangerous it would be for him to be at home for two weeks.”
Kirk believes Axel relapsed during this window. “I think he was using from Thanksgiving until he died.” Axel was twenty-nine.
The new CDC report suggests there may be tens of thousands of stories like Axel’s, in which people who were already susceptible to substance abuse found themselves suddenly socially isolated and disconnected from regular pursuits that gave them direction and purpose, and in many cases also squeezed financially, causing them to succumb.
And because dangerous amounts of fentanyl are increasingly finding their way into street drugs, more of those stories are ending tragically than ever before.
The first time Kirk learned about Axel’s use of hard drugs was in 2017, when he got a call while his folk-rock band, Consuelo’s Revenge, was playing a gig in Connecticut.
Kirk’s bandmate Ian drove him through the night to the hospital. Kirk was stunned, but Ian, a nurse, was used to situations like this one. Ian went into Axel’s hospital room, and “I read him the riot act,” Ian recalls. “I said, ‘Your father is really upset. You’re really fucking yourself up here.’ He was about as receptive as he could be lying in a hospital bed.”
A year later, Ian heard a knock at the door. Police officers informed him that his own son Max had overdosed — and probably wasn’t going to make it. Max was twenty-three. He miraculously survived but sustained injuries that left him with permanent disabilities.
Max and Axel’s experiences differed in key respects: Axel was addicted to opioids, but Max wasn’t. Max preferred other drugs, chiefly benzodiazepines like Xanax. When he overdosed, it was on cocaine laced with fentanyl.
But their stories share one important similarity, beyond the fact that they both lived in or near Providence and their dads played in the same band. Like Axel’s, Max’s fentanyl overdose was precipitated by a jarring separation from a job that made him feel grounded and valued.
Neither Max nor Axel went to college, and both entered their twenties with little certainty about what to do with themselves. Like Axel, Max often worked the Christmas rush at UPS. Other times, he worked as a cook or shoveled snow from the roofs of commercial buildings.
When Max went to vocational school and earned an auto mechanics license, Ian was optimistic that his son had found some direction. Max got a job putting that license to use, working on trucks. But Max had already developed a drug habit, and it hurt his focus and motivation. He was let go.
After Max lost that job, Ian started to notice signs of heavy drug use, easily recognizable to someone in his line of work. “It was a very rapid spiral,” he says. “He dove headlong into using benzos.”
Within weeks, Max had overdosed in an acquaintance’s basement and went without medical assistance for over twenty-four hours. (The acquaintance has also since died of a fentanyl overdose.)
The doctors told Ian that Max might never wake up, and if he did, he would likely be severely brain-damaged and have no quality of life. Ian had discussed the ethics of cases like this in nursing school and seen many real examples in his line of work and thought he knew how he would act in this scenario. “I had a very strict belief that food going in and waste coming out is not a life,” he says.
But Max was showing reflexes the doctors couldn’t explain. Ian opted to give him more time.
Max underwent a surgery that removed almost all of his right gluteal muscle, which had lost circulation and been damaged as he lay unconscious. (This type of injury, called compartment syndrome, happens a lot during overdoses.) The wound from the surgery left him in excruciating pain, causing him to cry out even before he was fully conscious. In a tragic irony, there was only one drug that was strong enough to treat pain that severe: fentanyl.
In a seaside suburb of Providence in the 1980s, Ian remembers coming across a series of books on psychoactive drugs in his high school library. At the beginning of each was an epigraph lifted from The Wizard of Oz: “I think you are a very bad man,” said Dorothy. “Oh, no, my dear; I’m really a very good man, but I’m a very bad Wizard, I must admit.”
Ian says he understands the meaning of the epigraph now. “Fentanyl is an amazing painkiller,” he says. “When my son needed it in the hospital, it worked tremendously.” But Ian explains that hospital protocol required Max to stay in a unit equipped with a ventilator while he was receiving fentanyl in case the drug slowed or stopped his breathing.
There had been no ventilator and no nurses monitoring his oxygen levels when Max encountered fentanyl in the wild.
Somebody to Be
In about 2014, overdoses from synthetic opioids like fentanyl shot up so dramatically that the line on the graph looks like an L tipped on its side. Axel and Max’s experiences both belong to that spike. Axel didn’t survive it. Max did, and his recovery far exceeded doctors’ expectations.
Max just moved into his own apartment in April. “Things are going great,” he told me over video chat. His eyes are bright with comprehension, but his voice is quiet and his sentences are short.
Max tells me he’s happy to have finally achieved independence after years of arduous recovery. He still struggles to walk and mostly uses a wheelchair, but he’s relearned how to do everything else. Once he’s more settled in, he says he plans to look for a job that doesn’t require him to be on his feet. For now, he spends his time doing his routine therapeutic exercises, cooking, and playing video games.
Max says low self-esteem inflamed his drug use. When he was a kid, he tells me, he’d been embarrassed by the sound of his voice. Ian had even taken Max to a speech therapist to help him with it. But while he overcame that early insecurity, he continued to measure himself against his peers and worry that he fell short. He desperately wanted to save enough money for an impressive car.
“I’m not the most confident person,” Max says, “but being high made me more confident.” The job he got with his mechanics license boosted Max’s self-image, but when he lost it, he compensated by increasing his drug use.
As an illegal drug user, it was only a matter of time before he came across a bad batch. Manufacturers of black-market drugs increasingly put fentanyl in their supply because it makes the high stronger. Fentanyl is also very addictive, causing clients to return for more — even when they don’t know why.
The Biden administration now has a full-blown fentanyl crisis on its hands. It seems ambivalent about how to address it, speaking both the language of harm reduction and carceral solutions. (Most drug policy experts and criminal justice advocates prefer the former).
But beyond greater access to addiction treatment and management, the massive spike in overdose fatalities during the pandemic suggests another critical element of effective drug policy.
The fact that fatal drug overdoses skyrocketed during the coronavirus crisis, when unemployment and social isolation reached staggering heights, suggests — as do Max and Axel’s stories — that people abuse substances when they’re feeling rudderless and dejected with few realistic opportunities for advancement. When I ask Max why he used drugs, his answer is spectacularly simple: “I just didn’t know what to do with my life.”
Whatever else our drug policy consists of, it won’t be sufficient to end the drug epidemic until we start investing in better life options for people who feel they have few, and work to give a sense of direction and purpose to people who have none.
During the pandemic, millions of people have found themselves stretched thin and stressed out, and left without anything to do, anyone to see, anyone to be. That’s a dangerous situation for people who are already vulnerable to drug use — it was before the pandemic and will be after. An agenda to address this underlying problem would include a jobs guarantee, an end to at-will employment, tuition-free college and trade school, and even public arts programming and recreational leagues.
In short, to end widespread drug abuse, we should give people meaningful ways to participate in society. The task is urgent, as the drugs they do instead are growing increasingly lethal.
Axel’s father Kirk agrees that the explosion of fentanyl onto the scene increases the exigency of changing our society’s approach to drugs. “Synthetic opioids, to me, represent an atom-bomb invention,” he says. “You can’t un-invent it. You can’t put the genie back into the bottle. Given that interdiction is a fool’s errand, how are we going to live with the genie?”